HIV knowledge and risk factors among men who have sex with men in Ho Chi Minh City,Vietnam

OBJECTIVES: To describe health risk behavior, knowledge, and attitudes about HIV/AIDS and its prevention in men who have sex with men (MSM) in Ho Chi Minh City (HCMC), Vietnam. METHODS: A cross-sectional survey of 219 MSM using a standardized questionnaire. RESULTS: Men who have sex with men were easy to locate and willing to answer detailed questions about their sexual behavior. Self-identified sexual orientation was 67% homosexual, 31% bisexual, and 1.4% heterosexual. High-risk sexual behavior was common. The mean number of sexual partners was 3.3 in the previous month and 14.8 in the previous year. Only 32% used condoms during their last intercourse, and only 40% used a condom when their last intercourse included anal sex. Eighty-one percent reported sex with nonregular male partners, and 22% also had sex with women in the past year. Drug use other than alcohol was rare. Most correctly identified high-risk sexual behavior and body fluids that could transmit HIV; however, only about half knew that someone who appeared healthy could transmit HIV or that there was no cure for AIDS. Self-rated risk for HIV was very low, and fewer than one third believed that homosexuals in Vietnam are at increased risk for HIV. CONCLUSION: Men who have sex with men in HCMC are at high risk for HIV. Knowledge about HIV transmission and prevention could be improved. Education and interventions specifically aimed at MSM are needed, because education targeted at the general population may not reach MSM or influence their behavior.     

Does the health belief model predict risky sexual practices in injection drug users?

The current research assessed Health Belief Model (HBM) constructs, sexual behaviour, and drug use practices in 123 heterosexual IDUs (62 men and 61 women) who were seronegative for HIV. Results indicated that HBM variables significantly explained 25% of the variance in condom usage in IDU men. Higher reports of condom usage were associated with negative attitudes related to condom discomfort, inconvenience, and acceptance; positive attitudes related to perceptions of condoms as adding excitement to sex; positive attitudes regarding condom efficacy and lower perceived susceptibility for AIDS. Alcohol, marijuana, and methadone usage explained an additional 21% of the variance in condom usage with alcohol use contributing positively to condom use while the other substances had negative contributions. HBM constructs did not significantly explain the variance in other risk behaviours in this group, however, control variables contributed to significant proportions of the variance in risky practices. HBM components did not significantly explain any of the variance in the sexual behaviours of IDU women, but demographic variables and substance use behaviours contributed to the variance in a number of sexual practices in this group. Based upon these findings, implications for clinical intervention are discussed.     

Black males who always use condoms: their attitudes, knowledge about AIDS, and sexual behavior.

One hundred six black males completed a questionnaire concerning attitudes and knowledge about the use of condoms and acquired immunodeficiency syndrome (AIDS). Of the 106 males in the study, 27 (26%) reported that they "always" used condoms, 31 (29%) did not use condoms and had low intentions of using them, and 48 (45%) reported high intentions to use condoms. Results indicated that knowledge about AIDS was exceptionally high for black males in all three groups. Black males with low intentions to use condoms reported significantly more negative attitudes about the use of condoms (eg, using condoms is disgusting) and reacted with more intense anger when their partners asked about previous sexual contacts, when a partner refused sex without a condom, or when they perceived condoms as interfering with foreplay and sexual pleasure. A significantly larger percentage of low intenders were treated for gonorrhea, syphilis, herpes, and genital warts than males in the other groups. Drug use did not differentiate the three groups, although marijuana was used more often by males in the low-intender group. Finally, a larger percentage of black males in the low-intender group reported experiences with anal intercourse and sex with a prostitute, but considered themselves at lower risk for AIDS than did their high-intender or steady-user counterparts.     

Condom use amongst out of school youths in a local government area in Nigeria

Background

Reported low condom use amongst out of school requires studying the context in which condom use occurs.

Methods

A cross sectional study of 350 out-of-school youth aged 15–24 years in a local government area of Nigeria was enrolled using cluster sampling.

Results

Those who had ever had sexual intercourse were 74.9%. Of these, 56.5% used no protection while 29.0% used condoms. Up to 78.6% have had sex within the preceding 12 months with 38.9% condom use. The commonest reason for non-condom use was that it reduces sexual enjoyment. Those who believed a single unprotected sexual exposure may result in HIV infection reported more condom use than those who believed otherwise (42% vs 27.2%, P<0.05). Those who had prior discussion with their partners on HIV/AIDS reported more condom use compared to those who had not (50% vs 25%, P<0.05). Also, those who had sexual intercourse occurring as a spontaneous event reported less condom use compared to those who have previously discussed about the possibility of having sex (68.0% vs 51.8%, P<0.05).

Conclusion

Condom use is likely to occur within relationships where opportunity exists for discussion on sexual matters. Thus, further studies are needed on communication and condom use within sexual partnerships.     

Condoms -- if you care

All barrier methods except the IUD offer some protection against both unwanted pregnancy and disease. Male and female condoms, however, are the most reliable barrier methods. While they occasionally leak, tear, or slip off and may not protect against syphilis, herpes, and genital warts if lesions are located on a body site not covered by the condom, condoms do reduce the risk of HIV transmission. Condom use to prevent HIV infection and other sexually transmitted diseases should not be promoted in isolation, but should be part of a national prevention and control strategy incorporating other elements such as information, blood safety, clean injection equipment, surveillance, counseling, and care and treatment. A well- developed condom promotion plan will be sensitive to policy, psychosocial, behavioral, and programmatic issues. Condom promoters and users should not ignore the reality that condoms interfere with love-making and contrast directly with the desired and expected carefree notion of the process. While acknowledging the negative aspects of condom use, the positive side of condoms can nonetheless be stressed. Just as car safety belts reduce the risk of adverse consequence in case of a crash, condoms should be worn as protection during sexual intercourse; once on, sex may be had with far less worry of pregnancy and disease. Finally, steps need to be taken to create social conditions in which people are comfortable discussing sexuality and past experiences with peers and prospective sex partners. Marketing professionals also need to be called upon to help make condom use a desirable social norm.     

Correlates of HIV risk-taking behaviors among African-American college students: the effect of HIV knowledge, motivation, and behavioral skills

This study identifies theoretically based predictors of condom use in a sample of 253 sexually active African-American college students recruited from two historically African-American colleges. The Information-Motivation-Behavioral (IMB) skills model of AIDS-preventive behavior was employed to delineate the roles of HIV/AIDS knowledge, experiences with and attitudes toward condom use, peer influences, perceived vulnerability, monogamy, and behavioral skills. A predictive structural equation model revealed significant predictors of more condom use including: male gender, more sexual HIV knowledge, positive experiences and attitudes about condom use, nonmonogamy, and greater behavioral skills. Results imply that attention to behavioral skills for negotiating safer sex and training in the proper use of condoms are key elements in reducing high risk behaviors. Increasing the specific knowledge level of college students regarding the subtleties of sexual transmission of HIV is important and should be addressed. Heightening students' awareness of the limited protection of serial monogamy, and the need to address gender-specific training regarding required behavior change to reduce transmission of HIV should be an additional goal of college health professionals.     

Unprotected sex among HIV-positive injection drug-using women and their serodiscordant male partners: role of personal and partnership influences

We investigated the characteristics of human immunodeficiency virus (HIV)-positive injection drug-using women who reported unprotected vaginal and/or anal sex with HIV-negative or unknown serostatus (serodiscordant) male partners. Of 426 female study participants, 370 were sexually active. Of these women, 39% (144/370) and 40% (148/370) reported vaginal and/or anal sex with serodiscordant main and casual partners, respectively. Sixty percent of women inconsistently used condoms with their serodiscordant main partners, whereas 53% did so with casual partners. In multivariate analysis, during sex with main partners, inconsistent condom users were less likely to feel confident about achieving safe sex (self-efficacy), personal responsibility for limiting HIV transmission, and that their partner supported safe sex. Inconsistent condom use was also more likely among women who held negative beliefs about condoms and in couplings without mutual disclosure of HIV status. Regarding sex with casual partners, inconsistent condom users were more likely to experience psychologic distress, engage in sex trading, but they were less likely to feel confident about achieving safe sex. These findings suggest that there are widespread opportunities for the sexual transmission of HIV from drug-using women to HIV-uninfected men, and that reasons vary by type of partnership. Multifaceted interventions that address personal, dyadic, and addiction problems are needed for HIV-positive injection drug-using women.     

Predictors of HIV Risk Among College Students: A CHAID Analysis1

SUMMARY The purpose of this study was to identify predictors of risk behaviors among college students and to determine how students differed in HIV risk practices. Participants were from six colleges and universities in a large southeastern metropolitan area. The present analysis was limited to participants who were 18 to 25 years of age; single; White, African American, or Asian; and reported initiation of sexual intercourse. The results demonstratedsignificant associations of gender and race with having sex within the past3 months, number of partners, condom use, length of time one knew one's sexual partner, substance use, and asking one's partner about sexualhistory. Using Chi-Square Automatic Interaction Detection (CHAID), the strongest predictor of condom use was noted to be gender, and the strongest predictor of number of partners was race. The findings of this study indicate that HIV risk factors vary dependingon a college student's ethnicity, gender, academic status, and substanceuse. Most importantly, African American men, particularly men who use drugs, and White and Asian men who use alcohol tend to report higher numbers of sexual partners. Females, particularly upperclass White females, and White men who do not use alcohol report infrequent condom use. These findings areuseful for health educators who have begun to recognize the importance ofconsidering the HIV risk factors of students and incorporating informationrelated to these factors into HIV prevention programs. From the results ofthis study, we have several suggestions that health educators and researchersmay want to consider when developing programs for college students: 1. Although students may not need extensive information about basic HIVfacts, they may need reinforcement of the information. In particular, students need to be made aware that lambskin condoms do not offer protection against HIV transmission. 2. Females need to be encouraged and taught the skills to negotiate theuse of and to actually use condoms. These skills need to be reinforced throughout college, particularly as women adopt other methods of birth control (i.e., the pill). 3. The general acceptance of condom use among African Americans and Asians may be a useful tool for the health educator. Promoting and reinforcingthis norm and behavior, while addressing some of the other risk factors inthese groups, may be a particularly effective approach to HIV prevention. 4. For White students whose condom use rates are lower, messages can include the use of condoms for STD and pregnancy protection. Messages for male students could include control over preventing pregnancy or sharing control for pregnancy prevention. 5. Couples often abandon using condoms when they feel they know each other “well enough.” Some guidelines for when to give up condoms might also be given to provide couples with responsible and realistic directions for minimizing their risk when choosing to engage in unprotected sex. These guidelines would include HIV testing two times at least 6 months apart, no evidence of STDs in either partner, and a commitment of both partners to a monogamous relationship. 6. When addressing the number of sexual partners as a risk factor, African American men and women may hold the greatest potential for change, given the greater likelihood of multiple partners in these groups. 7. With respect to drug and alcohol use, health educators may want to include discussions about the influence of drugs (particularly for African American students) and alcohol (particularly for White and Asian students) on inhibiting logical decision-making as it relates to sexual intercourse.     

Sex, Drugs, and HIV: Does Methadone Maintenance Reduce Drug Use and Risky Sexual Behavior?

This study examined differences in drug use, sexual behavior, attitudes, and perceptions of vulnerability for AIDS between injection drug users who received methadone treatment in the previous 6 months and those who did not. Of the 123 participants assessed, 62 (50%) received methadone treatment. Methadone patients reported fewer sexual partners and greater use of condoms compared to nonmethadone patients. Methadone patients also reported fewer high-risk sexual partners than those not in treatment. Women reported more high-risk partners than men. Methadone patients reported drinking alcohol less, but smoking marijuana more than nonmethadone users. Methadone users had more positive beliefs about the efficacy of condoms for preventing AIDS and expressed less anger than nonmethadone users in situations related to condom usage. These findings have important implications for using methadone maintenance to reduce the dual risk for HIV in injection drug users.     

Community norms for HIV risk behaviors among men in a South African township

We investigated alcohol-related sexual risk behavior from the perspective of social norms theory. Adults (N = 895, 62% men) residing in a South African township completed street-intercept surveys that assessed risk and protective behaviors (e.g., multiple partners, drinking before sex, meeting sex partners in shebeens, condom use) and corresponding norms. Men consistently overestimated the actual frequency of risky behaviors, as reported by the sample, and underestimated the frequency of condom use. Relative to actual attitudes, men believed that other men were more approving of risk behavior and less approving of condom use. Both behavioral and attitudinal norms predicted the respondents’ self-reported risk behavior. These findings indicate that correcting inaccurate norms in HIV-risk reduction efforts is worthwhile.     

Unsafe sex with casual partners and quality of life among HIV-infected gay men: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA)

INTRODUCTION: The introduction of highly active antiretroviral therapy has relaunched the debate on risky sexual behavior among HIV-infected gay men. It was proposed to study the influences of lifestyle characteristics and health-related quality of life (HRQL) on unsafe sex with casual partners in a representative sample of HIV-infected gay men. METHODS: In 2003, a national survey based on face-to-face interviews was conducted among a representative sample of patients selected in a random stratified sample of 102 French hospital departments delivering HIV care. The patients selected for this analysis were gay men who reported having had sex with casual partners during the previous 12 months. Unsafe sex was defined as at least 1 episode of anal sexual intercourse without a condom with a casual partner during the previous 12 months. Health-related quality of life was assessed using the SF-36 Scale. Patients who declared that they had engaged in unsafe sex were compared with those who declared that they had not done so, using the chi test and logistic regressions. RESULTS: Among the 1,117 gay men who participated in the study, 607 declared having had casual partners during the previous 12 months, and 140 (20%) of this latter group had engaged in unsafe sex. Poor mental HRQL was encountered in 68% of the patients and found to be independently associated with unsafe sex, even after multiple adjustment for number of partners, occurrences of binge drinking, use of anxiolytics, use of the Internet, and use of outdoor and commercial venues for sexual encounters. CONCLUSIONS: Risky sexual behavior with casual partners is frequent among HIV-infected gay men. In addition to other well-known factors, behavior of this kind was found in this study to be related to poor mental HRQL. A more comprehensive approach to care designed to improve mental quality of life might therefore make for more effective secondary prevention.     

Correlates of African American college students' condom use to prevent pregnancy,STDs, or both outcomes

BACKGROUND: The purpose of the current study was to compare African American college students who reported condom use for pregnancy prevention only, disease prevention only, and both pregnancy and STD prevention (i.e., dual prevention) in terms of their AIDS-related health beliefs, conventional sexual behavior, and unconventional sexual behavior. It was hypothesized that dual-prevention adolescents would express more health protective attitudes and behaviors than single-prevention individuals. METHOD: The sample consisted of 171 African American, undergraduate, single, heterosexual, and sexually active students with at least one partner in the past six months and who used condoms. A self-report questionnaire was administered-including items related to demographic and background information, sexual activity, condom use behavior, and knowledge, attitudes, and beliefs about HIV/AIDS, to participants in groups of 10-30 students in university classroom settings. RESULTS: The main between-group differences were in comparisons of pregnancy-prevention-only condom users and dual-prevention condom users. Participants who used condoms to prevent pregnancy only were less likely to be female, perceived themselves to be less susceptible to HIV/AIDS, perceived fewer barriers to condom use, and reported fewer vaginal sex partners. CONCLUSIONS: Intervention programs must address the relation between African American adolescents' beliefs about susceptibility to HIV/AIDS and unintended pregnancy, as well as their views of involvement in monogamous relationships. Integrated prevention services may allow for discussions of similarities and differences in the issues relevant to condom use for pregnancy prevention versus disease prevention.     

Risky sexual behavior in american white college women: the role of sex guilt and sexual abuse

Ninety-five sexually active White American female college students participated in a questionnaire study about their sexual behavior in the past 12 months. A path model was tested in order to assess specific hypothesized predictors of risky sexual behavior. As predicted, participants with greater sex guilt reported using condoms more and having had fewer sexual partners. The findings of this study suggest that White American female college students are at some degree of risk due to risky sexual behavior. Taking into account attitudes about sexuality and past sexual abuse along with the requisite training in condom use self-efficacy may enhance the success of interventions designed to reduce risky sexual behavior among White American female college students.     

Hiv risk behavior in male and female russian sexually transmitted disease clinic patients

Russia is experiencing one of the fastest growing HIV epidemics in the world. Russian sexually transmitted disease (STD) clinic patients are at elevated risk for infection with HIV and other STDs due to unsafe sexual behaviors. Future risk reduction intervention efforts for this group must be grounded in a solid understanding of the factors associated with risky behaviors. We collected information about the sexual behaviors, substance use, protective strategies, and HIV-related attitudes of 400 high-risk men and women presenting at an STD clinic in a major Russian metropolis. Alcohol use in conjunction with sexual activity was common in this sample (85%). One-third of study participants had more than 1 partner in the past 3 months, and about half (48%) of the sample had previously been diagnosed with an STD. However, despite this evidence of high-risk behavior, most participants (67%) reported using condoms less than half the time. High-risk behavior was associated with substance use and lower perceived severity of AIDS. Self-protective strategies differed by gender: men reported higher condom use rates whereas women reported efforts to limit their number of sexual partners. This study has important implications for the development of culturally tailored interventions to help stem the spread of HIV in Russia.     

Increasing condom use without reducing HIV risk: results of a controlled community trial in Uganda

BACKGROUND: Although consistent condom use is effective in reducing individual risk for HIV infection, the public health impact of condom promotion in a generalized epidemic is less clear. We assess the change in condom uptake and number of sex partners after a condom promotion trial in Kampala, Uganda. METHODS: Two similar poor urban communities near Kampala were randomized. One received a condom promotion program that taught condom technical use skills in workshops for men aged 18 to 30 years (n = 297) and encouraged condom use. Men in the control community (n = 201) received a brief informational presentation about AIDS. Participants received coupons redeemable for free condoms from distributors in both communities and completed questionnaires at baseline and 6 months later. RESULTS: Six-month follow-up was completed for 213 men (71.7%) in the intervention group and for 165 (82.1%) men in the control group. Men in the intervention group redeemed significantly more condom coupons than men in the control group (on average, 110 vs. 13 each; P = 0.002). Men in the intervention group increased their number of sex partners by 0.31 compared with a decrease of 0.17 partners in the control group (P = 0.004). Other measures did not support a net reduction in sexual risk in the intervention community compared with the control community and, in fact, showed trends in the opposite direction. CONCLUSIONS: In this study, gains in condom use seem to have been offset by increases in the number of sex partners. Prevention interventions in generalized epidemics need to promote all aspects of sexual risk reduction to slow HIV transmission.     

Informing school sex education using the stages of change construct: sexual behaviour and attitudes towards sexual activity and condom use of children aged 13-16 in England

A survey of 3820 school children in England aged 13-16 years examined sexual activity using the Transtheoretical Model (TTM) Stages of Change. A quarter (26%) of teens were sexually experienced, 44.8 per cent did not use contraception and 48.9 per cent did not use condoms, every time. Past history of condom and contraceptive use, and partner willingness to use condoms were the best predictors of being in Action or Maintenance stage for condom use. Of virgins, 19.82 per cent were in Contemplation or Preparation stages for intercourse, and 85.4 per cent would use condoms every time. Sex education should be tailored to Stage, and signposting to sexual health and contraception services.     

Why do heterosexual young adults who use reliable contraception also use condoms? Results from a diary‐based prospective longitudinal study

Objectives. To identify characteristics of individuals and characteristics of sexual encounters that predict whether people using contraception will also use condoms (dual use), and to determine whether dual use is prompted by concerns about unplanned pregnancy and/or sexually transmitted infections (STIs). Design. A longitudinal prospective design was used to identify characteristics of individuals and characteristics of specific sexual encounters that predict condom use. Methods. A sample of 349 sexually active heterosexual young adults was recruited at universities and trade colleges in Melbourne, Australia. Participants completed a self‐administered questionnaire, and a representative subsample (N = 103) completed a structured condom use diary in which they reported on up to 10 instances of vaginal intercourse. Respondents reported use of condoms and other forms of contraception during 919 instances of vaginal intercourse. Results. In multivariate analyses, dual use of condoms in addition to other contraception was predicted by attitudes toward condoms, intentions to use condoms, partner type and discussion of condom use with sexual partners. Dual use was not related to greater concern about HIV/STIs or unplanned pregnancy. Conclusion. Encouraging heterosexual young adults to discuss condom use, and developing their skills for negotiation of condom use will increase rates of condom use, thereby reducing current high rates of unplanned pregnancy and STIs.     

Attitudes toward using condoms and condom use: difference between sexually abused and nonabused African American female adolescents

Rates of many sexually transmitted diseases remain higher among adolescents than among any other age group. The associations between abuse experiences and risky sexual behaviors suggest that exploring the relationships between adolescents' abuse history and condom use beliefs and behaviors is warranted. Females (N = 725) attending an adolescent clinic reported demographic characteristics, beliefs about condom use, sexual behaviors, and sexual abuse or molestation history. Those reporting sexual abuse or molestation (23%) were more likely to think condoms interfered with sexual pleasure and less likely to think condoms were important to partners. They also reported more unprotected vaginal sex and more lifetime sex partners. Beliefs were correlated with condom use consistency, number of lifetime partners, and number of unprotected sex experiences. The greater levels of behavioral risk among those reporting abuse suggest greater risk for acquisition and transmission in abused female adolescents. The authors discuss hypotheses to inform future research and intervention.     

Assessing prevention achievements and failures: the importance of monitoring and evaluation

Aids prevention evaluations are necessary for determining whether the program is effective or moving in the expected direction and to satisfy donor requirements. The important issues are the methods of evaluation, when to conduct an evaluation, and how much money should be devoted to evaluation. Research is necessary in the beginning stage of program planning for program strategies, identification of the target audience, determination of the context of behavior, and cost effectiveness in reaching the target audience. Methods and materials for research need to be pretested in order to prevent failure and wasting money on full implementation. Quantitative as well as qualitative data may be extracted. During the early implementation stage, research is needed to monitor progress; appropriate methods might be participant observation, interviews, and/or focus groups. The aim is to measure the extent to which planned activities are actually being implemented and the extent to which the audience is being reached. The results might indicate whether efforts need to be enhanced or whether there are obstacles. Program effectiveness is also determined by an assessment of outcome after a period of time of operation. The program objectives determine what outcome measures are appropriate. It could be that there is measurement of whether risk practices decreased or knowledge and attitudes have changed. When knowledge, attitudes, and behavior changes are measured, self-reports are necessary, but biased. WHO's Global Program on AIDS has suggested using the following indicators: number of sexual partners, condom use, and reported incidence of sexually transmitted diseases. Observation is one method of measuring behavior change, which is not possible with sex behavior. One project measured condom use in sex worker locations by counting the number of discarded condoms in rooms, once the number of condoms distributed was known. Condom use may also be indirectly measured by condom sales or by counting the reduction in sexual partners. Feedback is also necessary as programs mature. The important question to ask is how pretesting, monitoring, feedback, and evaluation will contribute to program success.     

Human immunodeficiency virus-related risk behavior among African-American females

This study draws attention to the demographic shift in the population of HIV-infected African Americans from young, low-income, unmarried homosexual, and injecting drug users to female, heterosexual, higher income, and older persons. We used data from the 1995 Survey of Family Growth, sponsored by the National Center for Health Statistics, to examine the patterns of HIV-related risk behavior (consistent condom use, number of sexual partners, sex education in birth control methods) among African-American females. We found that only 33.3% of the African-American females had indicated that their partners always used condoms; 23.8% had seven or more lifetime sexual partners; and nearly 30% did not have any sex education in birth control methods, sexually transmitted diseases, or abstinence. In addition, African-American females who had partners who had not used condoms in the last 12 months were less likely than those who reported occasional condom use to perceive that they were infected with HIV (21.1% vs. 33.1%). These risk factors were prevalent among low-income African-American females with low socioeconomic status (SES) as well as black women with higher SES who lived in smaller cities and suburbs. These results highlight the need for HIV prevention strategies that cut across socioeconomic class, gender, sexual orientation, and place of residence.